In Liberia, Home Deaths Spread Circle of Ebola Contagion

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In Liberia, a Shortage of Treatment Centers for Ebola Patients

In Liberia, a Shortage of Treatment Centers for Ebola Patients

CreditDaniel Berehulak for The New York Times

MONROVIA, Liberia — The family of the sick man, who had endured Ebola’s telltale symptoms for six days, took him by taxi to treatment centers here in the capital twice, only to be turned back at the gate each time for lack of beds. He died at home, his arms thrashing violently and blood spewing out his mouth, in front of his sons.

“We had to carry him home two times because they could do nothing for us,” said Eric Gweah, 25, as a team of body collectors came to retrieve the corpse of his father, Ofori Gweah, 62. “The only thing the government can do is come for bodies. They are killing us.”

So many Ebola victims are dying at home because of the severe shortage of treatment centers here in Monrovia, Liberia’s capital, that they are infecting family members, neighbors and others in a ballooning circle of contagion.

Only 18 percent of Ebola patients in Liberia are being cared for in hospitals or other settings that reduce the risk of transmission by isolating them from the rest of the population, according to the Centers for Disease Control and Prevention. Unless that rate reaches 70 percent, the center predicted this week, Ebola cases will keep soaring.

In its worst-case estimate, Liberia and Sierra Leone, two of the three West African nations hit hardest by the outbreak, could face 1.4 million infections by Jan. 20 — more than 10 percent of their combined populations of about 10.3 million.

In the coming weeks, the United States military will try to overhaul the fight against Ebola in Liberia, home to 1,580 of the 2,800 Ebola deaths so far recorded in West Africa. The 3,000-strong American mission will not treat patients, but will build as many as 17 treatment centers, with a total of 1,700 beds, and try to train 500 health workers a week.

But building the centers is expected to take weeks and it is unclear who will run them, especially since the disease has decimated Liberia’s already weak health care system and the fear of Ebola has long kept many international aid workers away.

“I’ve worked in many crises for more than 20 years, and it’s the first time I can see a situation that nobody wants to come,” said Jean-Pierre Veyrenche, who is heading the World Health Organization’s efforts to build treatment centers here. “There’s plenty of money, so that’s not the issue.”

“People are afraid to come — that’s it,” he added.

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With treatment beds overflowing, the government is often left to simply pick up the bodies of the dead. As its six teams of body collectors crisscross this capital of 1.5 million people, navigating cratered streets left over from the 14-year civil war that ended in 2003, they encounter a city that is likely to remain at the mercy of Ebola for weeks, perhaps months.

Every day, each team retrieves a half-dozen to a couple of dozen bodies, delivering them to a crematorium at the end of the day.

The body collectors who came to pick up Mr. Gweah had descended to the compound where he lived four times in the past four weeks, down a steep cliff to a riverside area called Rockspring Valley. Each week, they had picked up a body that passed on the Ebola virus to the next person, and now Mr. Gweah’s was the fifth body. The crowd, seething beneath a sky of low clouds, erupted in anger.

“If the government can’t work it out, let them give it up,” said Marvin Gweah, 28, another son. “Let the international community handle this.”

Five body collectors in full protective suits clambered up the cliff in the rain, carrying his father’s body in a black plastic bag, resting to readjust their grip, and steadying themselves on the slippery path. Eric Gweah, his face twisted in anguish, led the way, shrieking “Papa!” and throwing his hands up in the air, nearly losing his footing.

“Stand up! Stand up!” a woman following the body collectors shouted at another woman who had fainted. A cacophony of wailing and sobbing rose as all of Rockspring Valley below seemed to sway in grief.

A new 120-bed treatment center, Island Clinic, operated by Liberian health workers under the W.H.O., opened here on Sunday, bringing Liberia’s total beds to 450. The agency is hoping to open two additional centers with a total of 400 beds here in the capital over the next month, but is unable to find international workers to operate them, Mr. Veyrenche said.

Last week in Bong County, in central Liberia, the International Medical Corps began operating a treatment center built by Save the Children. The Medical Corps and Doctors Without Borders are the only international organizations operating treatment centers in Liberia.

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Sean Casey, the leader of the International Medical Corps in Liberia, said he hoped to increase the center’s current capacity of 10 beds to 70 beds over the next six weeks. But because of the fear of Ebola and the time commitment required of foreign volunteers, the organization has been unable to draw doctors and nurses from its usual pool, he said. The organization is recruiting health workers for the first time in the Philippines, Jordan and Ethiopia.

Like most experts here, Mr. Casey was skeptical of the American military’s plans to find and train 500 health workers a week.

“It took us a few weeks to just open 10 beds,” he said. “It worries me that some of their facilities will be open before they’re ready.”

Here in Monrovia, the first city to face Ebola’s full onslaught since the virus was discovered in 1976, entire families are dying at home, unable to get a ride in one of the city’s few ambulances or gain admission to overcrowded treatment or holding centers.

“We came here for the husband last week, we’re back today for the wife, and maybe next week we’ll be back for the children,” said Alexander Nyanti, 23, a body collector who was picking up the corpse of Lorpu David, 30, in a central Monrovia neighborhood off Gurley Street.

A week earlier, his team visited the same house to retrieve the body of her husband, Sam David, the first Ebola death in that community. The couple shared one room with their two children and the wife’s younger sister.

“The little boy is not feeling all right,” John Sackie, the community’s chairman, said as four collectors pulled Ms. David out of a dark room in the back of the house, each grasping a limb.

Others from the community may have been exposed. Teddy Momo, 36, the husband’s nephew, said he had taken the ailing Ms. David to an Ebola treatment center, riding in the front passenger seat of a taxi as Ms. David shared the back with her two children and sister.

Turned away because of a lack of beds, they took the taxi back to Gurley Street. But Ms. David slipped and hit her chin on a rocky path leading to her house; a neighbor carried her home, where she died immediately, Mr. Momo said.

Even if there were enough treatment centers, not all families would send their sick relatives to them. Deeply distrustful of the government and fearful of becoming social outcasts, families often lie about the cause of death, furthering the contagion throughout their communities.

In front of the gate at the John F. Kennedy Medical Center’s maternity ward, a pregnant woman lay dead in the back seat of a taxi. She had died during labor and did not suffer from Ebola, her family insisted. But a hospital worker said the woman had been bleeding from her mouth, so she had been turned away from the maternity ward. When the body collectors finally opened the taxi door, they found that she had vomited blood.

In the Matadi neighborhood, community leaders, including a member of the local Ebola task force, said emphatically that another death, of a 24-year-old man, had resulted from epilepsy. But again, the body collectors found blood coming from his mouth, more evidence of the virus.

In a neighborhood called PHP, community leaders who had gathered in a mosque explained that a 75-year-old woman had died of a stroke. Absolutely no Ebola, they said, as Mark Korvayan, 37, the leader of a team of body collectors, nodded.

But as his team went to pick up the body from a dank room, Mr. Korvayan said that he had picked up the woman’s daughter and nephew from the same room in the past month.

As he had often seen, this community, caught up in its own denials, continued to engage in funeral practices that helped spread Ebola, he said. “They told me that somebody even bathed the old woman’s body.”

Clair MacDougall contributed reporting.

A version of this article appears in print on September 25, 2014, on Page A1 of the New York edition with the headline: Home Deaths Spread Circle of Contagion. Order Reprints|Today's Paper|Subscribe